Provider Demographics
NPI:1881622181
Name:ESCOBAR, DIEGO (MD)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DIEGO
Other - Middle Name:
Other - Last Name:ESCOBAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6989 E FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1714
Mailing Address - Country:US
Mailing Address - Phone:813-935-4210
Mailing Address - Fax:813-932-1503
Practice Address - Street 1:3000 MEDICAL PARK DR STE 430
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4681
Practice Address - Country:US
Practice Address - Phone:813-615-7160
Practice Address - Fax:813-615-7173
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236217207R00000X
FLME1563752083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5N8621Medicare ID - Type Unspecified
NYI29621Medicare UPIN